Insuficiência cardíaca : o valor da tomada de decisão apoiada pela evidência

© 2020 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L.U. This is an open access article under the CC-BY-NC-ND license.Heart failure (HF) was identified as an emerging epidemic more than two decades ago, and is currently estimated to affect at least 26 million people worldwide. HF is a complex syndrome that is difficult to define, characterized by the heart's inability to meet the body's metabolic demands resulting from structural and/or functional impairment of ventricular filling or ejection. Diagnosis is largely clinical, based on symptoms and signs, for which imaging techniques (particularly echocardiography) and measurement of neurohormonal peptides are crucial. Although in most cases the focus is on symptomatic HF, a proportion of high-risk patients may have no symptoms despite reduced left ventricular ejection fraction, and they may also benefit from medical therapies that favorably impact prognosis.info:eu-repo/semantics/publishedVersio

Prognostic relevance of exercise testing in hypertrophic cardiomyopathy. A systematic review

© 2021 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).Background: Cardiopulmonary exercise test (CPET) is indicated as part of the assessment in hypertrophic cardiomyopathy (HCM) patients and stress echocardiography is often used to assess symptoms. However, the role of exercise testing for prognostic stratification in HCM is still not established. Aims: To systematically review the evidence on the role of exercise testing for prognostic stratification in hypertrophic cardiomyopathy. Methods: A systematic review was conducted for eligible publications, between 2010 and 2020, that included evaluation of outcomes and prognosis. In these studies, patients underwent exercise echocardiography and/or cardiopulmonary exercise testing, performed according to predefined protocols. Diverse parameters were assessed in order to determine which were relevant for the prognosis. Analyzed outcomes included death from any cause, sudden cardiac death (SCD) and equivalents, cardiovascular death, heart failure requiring hospitalization or progression to New York Heart Association classes III or IV, cardiac transplantation, non-sustained ventricular tachycardia, stroke, myocardial infarction and invasive septal reduction therapy. Results: Eighteen publications were included, corresponding to a total of 7525 patients. The mean follow-up period varied between 1 and 8 years. The main findings of these studies revealed that the major predictors of outcomes were abnormal heart rate recovery, abnormal blood pressure response exercise induced wall motion abnormalities, lower peak VO2, higher VE/VCO2, and pulmonary hypertension/exercise-induced pulmonary hypertension. Conclusion: Although most studies concluded that exercise test results are useful to determine prognosis in HCM, further investigation is needed regarding whether it adds independent value to the current risk stratification strategies.info:eu-repo/semantics/publishedVersio

A análise do erro na escrita escolar : um estudo com alunos do 6º ano na cidade da Praia

Mestrado em Didáctica de Línguas - Português Língua não MaternaCom este trabalho pretendíamos identificar/analisar as causas dos desvios nas produções escritas de seis alunos do 6º ano de escolaridade em Cabo Verde, mais concretamente na cidade da Praia, e, por outro lado, averiguar a consciência metalinguística nas suas verbalizações metalinguísticas. Doze textos escritos (dois para cada aluno) e a transcrição do registo sonoro das verbalizações metalinguísticas constituíram o corpus analisado. A análise de dados incidiu na interpretação dos erros constantes nas produções escritas e nos comentários metalinguísticos dos alunos. Os resultados demonstraram que a interferência do Crioulo Cabo-verdiano está na base da maioria dos desvios registados na Língua Portuguesa (língua de ensino em Cabo Verde). A consciência metalinguística revelou-se apenas na sinalização/correcção de erros. Este estudo poderá ainda, constituir subsídio para o ensino/aprendizagem da língua segunda. ABSTRACT: The objective of this assignment was in one hand to identify and analyze the deviation causes on written works of six students with six years of schooling in Cape Verde and more specifically from the city of Praia and on the other hand to verify the metalinguistic awareness of these students in their metalinguistic expressions. A total of twelve written texts (two for each student) and sound registries of their meta-linguistic expressions constituted the corpus of this analyzes. The data analysis focused on interpretation of constant mistakes made on written texts and on the student’s meta-linguistic comments. The results showed that the majority of deviations from the Portuguese Language were caused by interferences of the Capeverdian creole language. The linguistic consciousness was only reveled in punctuation and correction of mistakes. This study can be used as a subsidy for the teaching and learning of the second language

Intimidade e vida sexual: mudanças e continuidades numa perspectiva de género e geração

Esta tese tem como objectivo geral identificar mudanças ocorridas nas últimas décadas nas formas de experienciar e dar sentido à vida íntima e sexual, seguindo uma perspectiva especialmente atenta ao género e à geração. Em particular, centramos a nossa análise no contexto das práticas e normas da heterossexualidade e do ordinary sex, reconhecendo o interesse analítico, o pluralismo e o carácter transformacional compreendidos na heteronorma. Conciliando os níveis micro e macro, a pesquisa adopta uma estratégia metodológica múltipla, que combina a análise de 66 entrevistas biográficas aplicadas a linhagens familiares femininas e masculinas (Avôs/Pais/Filhos, Avós/Mães/Filhas) com o tratamento de dados quantitativos provenientes da aplicação de um inquérito a uma amostra representativa da população portuguesa. A pesquisa assume a sexualidade como um fenómeno socialmente construído e, por isso, em constante diálogo com outras esferas da vida social. Guiada pelas gerações, a análise integra as mudanças ocorridas neste campo no quadro de transformações ocorridas na sociedade portuguesa ao longo das últimas décadas. Desta forma, investigam-se mudanças e continuidades na aproximação entre as trajectórias afectivas e sexuais de homens e mulheres, e investigam-se também as normas face ao género e à intimidade sexual, primeiro através da revisão crítica dos pressupostos da liberdade e da igualdade sexuais, e depois, através da análise das transmissões de normas face ao género e à sexualidade que, de umas gerações para outras, vão tendo lugar nas famílias.The aim of this doctoral dissertation is to identify, through a gender and generation based perspective, the changes that occurred in the meanings and forms of experiencing intimacy and sexual life over the past few decades. We focus our analysis particularly on the heterosexual context, recognizing the analytical interest, the pluralism and the transformational character of ordinary sex. Based on a micro and macro approach, the research adopts a plural methodology, combining the analysis of 66 biographical interviews applied to male and female family lineages (Grandparents/Fathers/Sons, Grandmothers/Mothers/Daughters) with quantitative data from a survey applied to a representative sample of the Portuguese population. The research deems sexuality as a social phenomenon, one that is intrinsically connected to other spheres of social life. While linked to generations, intimacy and sexuality fit into the broader transformations of Portuguese society over the last few decades. Thus, we investigate changes and continuities in the convergence between masculine and feminine sexual trajectories, and we also investigate sexual normativities, first, through a critical review of the more libertarian and egalitarian assumptions on intimate life, and then through the analysis of the normative transmissions that, from one generation to the other, take place in families with regard to gender and sexuality

Un caso único de distrofia muscular facioscapulohumeral tipo 1 y miocardiopatía hipertrófica sarcomérica

© 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.info:eu-repo/semantics/publishedVersio

Reducing the Bloater Spoilage During Lactic Fermentation of Moroccan Green Olives

The process of natural lactic fermentation of green olives is too long and usually associated with several types of olive deteriorations, mainly the »bloater spoilage«. The control of pH and salt level in brine, a practice mostly used in the olive industry, is not sufficient to avoid these problems. The main objective of this work is the control of the fermentationprocess in order to reduce the duration of the process and the olive spoilage incidence.Therefore, some Moroccan green olives were alkali-treated and brined at 5 % NaCl. The controlled fermentation was carried out by adjusting pH, by inoculation with Lactobacillus plantarum I159 and the addition of potassium sorbate (0.05 % brine). The results showed arapid development of lactic fermentation with a remarkable reduction in »bloater spoilage «, without affecting the organoleptic properties, colour and texture of the final product

Reducing the Bloater Spoilage During Lactic Fermentation of Moroccan Green Olives

The process of natural lactic fermentation of green olives is too long and usually associated with several types of olive deteriorations, mainly the »bloater spoilage«. The control of pH and salt level in brine, a practice mostly used in the olive industry, is not sufficient to avoid these problems. The main objective of this work is the control of the fermentationprocess in order to reduce the duration of the process and the olive spoilage incidence.Therefore, some Moroccan green olives were alkali-treated and brined at 5 % NaCl. The controlled fermentation was carried out by adjusting pH, by inoculation with Lactobacillus plantarum I159 and the addition of potassium sorbate (0.05 % brine). The results showed arapid development of lactic fermentation with a remarkable reduction in »bloater spoilage «, without affecting the organoleptic properties, colour and texture of the final product

PROYECTO DE EXPORTACIÓN DE MEZCAL ARTESANAL DE OAXACA A SANTIAGO DE CHILE, 2016.

La industria del mezcal goza de una enorme tradición en gran parte de la república mexicana, sin embargo, sólo ocho estados se encuentran protegidos por la denominación de origen1. Datos del Consejo Mexicano Regulador del Mezcal (Comercam) arrojan que en el país alrededor de 20,000 familias viven de los ingresos que genera esta industria. Por lo antes expuesto, es que se vuelve necesario proponer y analizar potenciales mercados de consumo que contribuyan al crecimiento de la industria en el estado de Oaxaca y por ende en el país, priorizando el aprovechamiento de los acuerdos comerciales de los que México forma parte y la ventaja que brinda contar con una 1 Según información obtenida de la página oficial del Consejo Regulador del Mezcal, los ocho estados con denominación de origen son: Durango, Guerrero, Guanajuato, Michoacán, Oaxaca, San Luis Potosí, Tamaulipas y Zacatecas. 8 protección como lo es una denominación de origen, llegando así al planteamiento de la hipótesis de este trabajo la cual dice: “El proyecto de exportación de mezcal artesanal de Oaxaca a Santiago de Chile es viable, factible y rentable, ya que es un mercado potencial para el consumo de este producto.” El objetivo general será el de Identificar la oportunidad de negocio que existe para exportar mezcal artesanal de Oaxaca a Santiago de Chile, evaluando su factibilidad y viabilidad. Mediante la realización de un estudio sobre los requerimientos necesarios para comercializar mezcal artesanal en Santiago de Chile y la evaluación de la rentabilidad generada al exportar mezcal artesanal a dicho mercado. Esto se desarrollará en 4 capítulos. En el primero de éstos se describirá brevemente la historia del comercio internacional, y se enunciarán las relaciones comerciales que tiene México con el mundo y más específicamente con Chile, así como la teoría en que se basa este proyecto de exportación. El segundo capítulo abordará todo lo referente al mezcal, tipos y clases, NOMs, oferta nacional e internacional. Después el tercer capítulo hará un análisis del mercado meta (Santiago de chile) el cual incluirá todos los datos macro y micro necesarios para la elaboración de un estudio de mercado. Por último, en el estudio financiero se determinará la viabilidad del proyecto mediante un análisis de la inversión y de distintas variables de carácter financiero como lo son el punto de equilibrio y la Tasa interna de retorno (TIR)

Endometriosis and cardiovascular disease: a systematic review and meta-analysis

© 2023 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/Objectives: Endometriosis is a benign, estrogen-dependent, chronic inflammatory disease and is the commonest cause of chronic pelvic pain in younger women. Cardiovascular disease is the main cause of death worldwide. Because the relationship between endometriosis and CV disease is not well established, we performed a systematic review of longitudinal studies that assessed the occurrence of cardiovascular events in women with endometriosis compared to those without endometriosis. Study design: Systematic review with meta-analysis of longitudinal cohort/nested case-control studies with endometriosis patients and controls. A search was conducted of the MEDLINE, CENTRAL, and Embase databases from inception to November 2022. Random-effects meta-analysis was performed to estimate pooled hazard ratios (HR) and 95 % confidence intervals (95%CI). Main outcome measure: Cardiovascular outcomes such as ischemic heart disease and cerebrovascular disease. Results: Six cohort studies were included, with a total of 254,929 participants. Meta-analysis showed that endometriosis was associated with a significantly increased risk of ischemic heart disease (HR 1.50, 95%CI 1.37–1.65; I 2 = 0 %) and cerebrovascular disease (HR 1.17, 95%CI 1.07–1.29; I 2 = 0 %). The one study that examined the relationship between cardiovascular mortality and endometriosis found a decreased risk in women with endometriosis relative to women without endometriosis (HR 0.55 (95%CI 0.47–0.65)). Conclusions: Endometriosis is associated with a significantly increased risk of cardiovascular disease, namely ischemic heart disease and cerebrovascular disease. Further studies are required to determine if endometriosis and/or its treatments are risk factors (particularly for cardiovascular mortality), and whether preventive measures could reduce the burden of cardiovascular disease in women with endometriosis. Study protocol registered at PROSPERO: CRD42022298830.info:eu-repo/semantics/publishedVersio

Sacubitril/valsartan : um guia prático

© 2019 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. Todos os direitos reservados.Renin-angiotensin-aldosterone system (RAAS) inhibitors are a cornerstone in the treatment of heart failure with reduced ejection fraction (HFrEF). Sacubitril/valsartan modulates the neurohormonal axis by inhibiting both angiotensin receptors and neprilysin, and improves neurohormonal balance more than blocking the RAAS alone. The PARADIGM-HF trial validated this new treatment option for patients with HFrEF. Sacubitril/valsartan was also more effective than enalapril in slowing disease progression by decreasing the risk of worsening heart failure requiring hospitalization or emergency admission and the need for intensified therapy, heart failure devices or cardiac transplantation. More than 70% of patients included in PARADIGM-HF were in NYHA class II, and overall, the results indicate that sacubitril/valsartan should be started in the earliest symptomatic stages of the disease. As PARADIGM-HF has excellent robustness for a cardiovascular trial, sacubitril/valsartan has been included as a new treatment option with a strong level of recommendation in the main international guidelines. This expert task force proposes a practical guide to the use of this new drug that has been endorsed by the Working Group on Heart Failure of the Portuguese Society of Cardiology.Os inibidores do sistema renina-angiotensina-aldosterona são uma das pedras basilares no tratamento da insuficiência cardíaca com fracção de ejecção reduzida. O sacubitril/valsartan promove a modulação neuro-hormonal, bloqueando os recetores da angiotensina e inibindo a neprilisina, e produz um maior equilíbrio neuro-hormonal, mais do que o bloqueio do sistema renina-angiotensina-aldosterona isoladamente. O estudo PARADIGM-HF validou essa nova opção para o tratamento de doentes com insuficiência cardíaca e fração de ejecção reduzida, em alternativa ao IECA/ARA. O sacubitril/valsartan demonstrou ser mais eficaz do que o enalapril em retardar a progressão da doenca, diminuindo o risco de agravamento da insuficiência cardíaca através da diminuição da necessidade de hospitalizacão e da menor necessidade de intensificação terapêutica, dispositivos ou transplante cardíaco. Mais de 70% dos doentes incluídos no estudo PARADIGM-HF estavam em classe II da NYHA, suportando a utilização do Sacubitril/Valsartan precocemente após o início dos sintomas. Como o estudo PARADIGM-HF apresentou uma robustez sem precedentes para um estudo cardiovascular, o Sacubitril/Valsartan foi incluído como uma nova opção de tratamento nas Recomendações internacionais mais relevantes, com um elevado nível de evidência (I-B). Este grupo de peritos em Insuficiência Cardíaca vem propor uma orientação prática para a utilização deste novo fármaco, subscrita pelo Grupo de Estudos de Insuficiência Cardíaca da Sociedade Portuguesa de Cardiologia.info:eu-repo/semantics/publishedVersio